| 1. |
- Bromley Milton, Maria, et al.
(author)
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Is Pain Intensity Really That Important to Assess in Chronic Pain Patients? A Study Based on the Swedish Quality Registry for Pain Rehabilitation (SQRP)
- 2013
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 8:6
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Journal article (peer-reviewed)abstract
- BackgroundIncorporating the patient's view on care and treatment has become increasingly important for health care. Patients describe the variety of consequences of their chronic pain conditions as significant pain intensity, depression, and anxiety. We hypothesised that intensities of common symptoms in chronic pain conditions carry important information that can be used to identify clinically relevant subgroups. This study has three aims: 1) to determine the importance of different symptoms with respect to participation and ill-health; 2) to identify subgroups based on data concerning important symptoms; and 3) to determine the secondary consequences for the identified subgroups with respect to participation and health factors.Methods and SubjectsThis study is based on a cohort of patients referred to a multidisciplinary pain centre at a university hospital (n = 4645, participation rate 88%) in Sweden. The patients answered a number of questionnaires concerning symptoms, participation, and health aspects as a part of the Swedish Quality Registry for Pain Rehabilitation (SQRP).ResultsCommon symptoms (such as pain intensity, depression, and anxiety) in patients with chronic pain showed great variability across subjects and 60% of the cohort had normal values with respect to depressive and anxiety symptoms. Pain intensity more than psychological symptoms showed stronger relationships with participation and health. It was possible to identify subgroups based on pain intensity, depression, and anxiety. With respect to participation and health, high depressive symptomatology had greater negative consequences than high anxiety.ConclusionsCommon symptoms (such as pain intensity and depressive and anxiety symptoms) in chronic pain conditions carry important information that can be used to identify clinically relevant subgroups.
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| 2. |
- Grooten, Wilhelmus Johannes Andreas, et al.
(author)
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Summarizing the effects of different exercise types in chronic low back pain : a systematic review of systematic reviews
- 2022
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability.METHODS: We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022-01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE.RESULTS: Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention.CONCLUSIONS: Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources.TRIAL REGISTRATION: PROSPERO: Reg no 190409 Registration date 01AUG 2020.
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| 3. |
- Lisik, Daniil, et al.
(author)
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Prevalence of sensitization to molecular food allergens in Europe: A systematic review.
- 2022
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In: Clinical and translational allergy. - : Wiley. - 2045-7022. ; 12:7
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Journal article (peer-reviewed)abstract
- Recent reports indicate that the prevalence of food allergy is increasing, but accurate estimates remain a challenge due to cross-reactivity and limited use of precise diagnostic methods. Molecular allergy diagnostics, in which sensitization to individual molecular allergens is measured, is emerging as a promising tool for evaluation of sensitization profiles. In this systematic review, we summarized estimates of prevalence of sensitization to molecular food allergens in the general population in Europe.Following a protocol prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; reference CRD42021266657), we searched seven databases with no restrictions on publication date or language. Two reviewers independently screened the literature, extracted data, and appraised the risk of bias in the included studies. The findings were synthesized narratively.From 4776 de-duplicated records, five studies, with low to moderate overall risk of bias, were included. Forty-six molecular allergens from 18 foods were investigated. Overall, the prevalence of sensitization was low, particularly for major allergens, and non-existent for 10 molecular allergens (0% [95% CI 0-0.8]). The highest prevalence was seen for PR-10 proteins, such as Cor a 1.04 (13.6% [95% CI 10.9-16.9]).Available data, primarily from North-western Europe, indicate that sensitization to molecular food allergens is overall low. The highest estimates were found for cross-reactive PR-10 proteins. There were not enough studies to discern regional differences or perform meta-analysis, highlighting the need for more population-representative studies in order to elucidate patterns of sensitization to molecular food allergens in Europe.
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| 4. |
- Rasmussen-Barr, Eva, et al.
(author)
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Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews
- 2023
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In: BMC Musculoskeletal Disorders. - 1471-2474. ; 24:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence.METHODS: We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible.RESULTS: Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low (n = 13) to moderate to high (n = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available.CONCLUSION: Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality.TRIAL REGISTRATION: Prospero CRD42022336014.
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| 5. |
- Rovner, Graciela, 1959
(author)
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Acceptance & Commitment Therapy (ACT)
- 2012
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In: Hälsofrämjande möten : från barnhälsovård till palliativ vård. Reds: Hertting, Anna; Kristenson, Margareta. - Lund : Studentlitteratur. - 9789144070452
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Book chapter (other academic/artistic)abstract
- Varje dag sker tusentals möten i svensk hälso- och sjukvård. Dessa möten fungerar många gånger bra och patienten går stärkt ur sitt möte. Men alltför ofta blir det inte så. Det framgår i nationella patientenkäter och forskning. Det goda, hälsofrämjande mötet stärker människors tilltro till sin egen förmåga. Eftersom tankar och känslor är nära kopplade till fysiologiska reaktioner kan ett hälsofrämjande möte också stärka individens läkeförmåga. Om vi på ett klokt sätt kombinerar dessa kunskaper med andra medicinska landvinningar öppnas nya möjligheter för framtidens hälso- och sjukvård. Boken beskriver de principer som ett hälsofrämjande möte bygger på och illustrerar hur det kan se ut i praktiken. I boken framgår även att bemötande är en kompetens som går att lära sig. Exempel ges från många delar av vården och författarna representerar flera professioner. De vill med sina erfarenheter stödja det nytänkande som krävs för att få till stånd en mer hälsofrämjande vård och omsorg. Boken vänder sig till alla som vill utveckla sin förståelse för mötets betydelse för patientens hälsa: yrkesverksamma, studenter på grund- och avancerad nivå, chefer, tjänstemän och beslutsfattare inom hälso- och sjukvård. För den intresserade allmänheten är boken en värdefull guide till en ny patientroll.
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| 6. |
- Rovner, Graciela, 1959
(author)
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Acceptans och mindfulness – ett fysioterapeutiskt förhållningssätt
- 2012
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In: Att förstå kroppens budskap : sjukgymnastiska perspektiv / redaktörer: Gabriele Biguet, Riitta Keskinen-Rosenqvist, Adrienne Levy Berg. - Lund : Studentlitteratur. - 9789144073217
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Book chapter (other academic/artistic)abstract
- Ohälsa kan spegla en människas hela livssituation och symtom är ofta ett uttryck för bristen på begriplighet, hanterbarhet och mening. Bristande kroppstillit och främlingskap inför den egna kroppen kan ses vid all form av sjukdom. Kroppen förstås som meningsbärare och därmed blir helhetsperspektivet en förutsättning för behandling och tillfrisknande. Tjugo erfarna sjukgymnaster belyser i boken den holistiskt orienterade sjukgymnastiken baserad på modern forskning. Den levda kroppen är utgångspunkt ?i behandlingen. Centralt är interaktionen och det kroppsnära mötet mellan sjukgymnast och patient, vars egna resurser tillvaratas. Boken består av flera delar med teoretiska förståelsemodeller och konkreta sjukgymnastiska arbetssätt. Den röda tråden i boken är kroppens mening, kroppstillit, affekt och kroppsmedvetenhet. Övriga teman som belyses är mentaliseringsförmåga, autonom reglering, sensomotoriskt lärande, fysisk aktivitet, acceptans och kroppsligt förankrad närvaro i nuet. Metoderna Basal Kroppskännedom? och psykomotorisk fysioterapi presenteras. Exempel ges på hur helhetssyn kan tillämpas vid långvarig smärta, psykiskt trauma, kronisk mag-tarmsjukdom, lårbensamputation, ångest och psykotiska tillstånd. Boken vänder sig till studenter på högskolenivå inom vårdsektorn (främst sjukgymnaster/fysioterapeuter men även arbetsterapeuter, läkare, psykologer, socionomer/kuratorer och sjuksköterskor) både på grund- och avancerad nivå, samt till kliniskt verksamma inom vård och rehabilitering samt den intresserade allmänheten.
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| 7. |
- Rovner, Graciela, 1959, et al.
(author)
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Chronic pain and sex-differences; women accept and move, while men feel blue.
- 2017
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In: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 12:4
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Journal article (peer-reviewed)abstract
- The aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation.1371 patients referred to a specialty pain rehabilitation clinic, completed sociodemographic and pain related questionnaires. They rated their pain acceptance (CPAQ-8), their kinesiophobia (TSK), the impact of pain in their life (MPI), anxiety and depression levels (HAD) and quality of life scales: the SF-36, LiSat-11, and the EQ-5D. Because of the large sample size of the study, the significance level was set at the p ≤.01.Analysis by t-test showed that when both sexes experience the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level.Pain acceptance (CPAQ-8) and kinesiophobia (TSK) showed the clearest differences between men and women. Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.
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| 8. |
- Rovner, Graciela, 1959, et al.
(author)
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Latent Class Analysis of the Short and Long-Form of the Chronic Pain Acceptance Questionnaire- Further Examination of Patient Subgroups. : Latent Class Analysis of the CPAQ
- 2015
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In: The journal of pain : official journal of the American Pain Society. - : Elsevier BV. - 1528-8447 .- 1526-5900. ; 16:11, s. 1095-1105
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Journal article (peer-reviewed)abstract
- A substantial literature indicates that pain acceptance is a useful behavioral process in chronic pain rehabilitation. Pain acceptance consists of willingness to experience pain and to engage in important activities even in the presence of pain and is often measured using the Chronic Pain Acceptance Questionnaire (CPAQ). Previous traditional cluster analyses of the 20-item CPAQ identified three patient clusters which differed across measures of patient functioning in meaningful ways. The aims of this study were to replicate the prior study in a new sample, using the more robust method of Latent Class Analysis (LCA), and to compare the cluster structure of the CPAQ and the shorter CPAQ-8. In total, 914 patients with chronic pain completed the CPAQ and a range of measures of psychological and physical function. Patient clusters identified via LCA were then used to compare patients across functional measures. Contrary to previous research, LCA demonstrated that a four-cluster structure was superior to a three cluster. Consistent with previous research, cluster membership based on patterns of pain willingness and activity engagement was significantly associated with specific patterns of psychological and physical function, in line with theoretical predictions. These cluster structures were similar for both CPAQ-20 and 8-items. These results provide further evidence of the relevance of chronic pain acceptance, and a more nuanced understanding of how the components of acceptance are related to function.
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| 9. |
- Rovner, Graciela, 1959, et al.
(author)
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Psychometric properties of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) in a Swedish Chronic pain cohort
- 2014
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In: Journal of Rehabilitation Medicine. - : Stiftelsen Rehabiliteringsinformation. - 1650-1977 .- 1651-2081. ; 46:1, s. 73-80
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Journal article (peer-reviewed)abstract
- Background: Acceptance and Commitment Therapy for chronic pain has good empirical support. Pain acceptance is most often assessed with the Chronic Pain Acceptance Questionnaire (CPAQ). Recently a shorter 8-item version, the CPAQ-8, was developed. Objectives: To further validate the CPAQ-8 in a Swedish context and to test its sensitivity to treatment effects, an as-yet unknown property of the instrument. Methods: A total of 891 patients completed the CPAQ, along with scales for anxiety and depression (Hospital Anxiety and Depression scale), kinesiophobia (Tampa Scale for Kinesiophobia) and quality of life (Short Form-36). Confirmatory factor analyses were performed to examine the factor structure. Convergent validity was tested with Pearson's correlations. Changes over time were evaluated with paired t-test. Results: The confirmatory factor analyses showed that the CPAQ 2-factor model had a better fit compared with the 1-factor model, both for the 8- and 20-item versions. All CPAQ-8 scales demonstrated good internal consistency (alpha ≥ 0.80). They also correlated significantly with related constructs, supporting convergent validity. The CPAQ-8 explained a large share of the total variance in CPAQ-20 and was also able to track rehabilitation changes (large effect size, d = 0.89). Conclusion: CPAQ-8 demonstrated good psychometric properties and sensitivity to rehabilitation changes. Further research that considers other cultural contexts may lead enhance the applications of this instrument.
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| 10. |
- Rovner, Graciela, 1959
(author)
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SMÄRTA OCH STRESSHANTERING. KAN EN KORT KURS I STRESSHANTERING FÖRBÄTTRA SMÄRTPROGNOSEN FÖR POLIKLINISKA PATIENTER?
- 2003
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In: C-Uppsats.
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Conference paper (other academic/artistic)abstract
- Syftet med denna studie är att testa om en gruppbehandling i form av en kurs i stresshantering och copingstrategier med kognitiv-psykologisk inriktning kan förbättra smärtprognosen hos en grupp polikliniks smärtpatienter samt observera hur detta påverkar variablerna smärta och stress: mätningen gjordes före och efter behandlingen med Lintons "Frågeformulär om smärtproblem (3)" samt kommentarer ur patientens dagbok under kursen. Gruppen bestod av patienter från två vårdcentraler med smärta i rörelseapparaten som inte var sjukskrivna alls eller max 50% och inte längre än 2 månader. Kursen pågick under 5 veckor, en gång i veckan. Resultatet visade en signifikant förbättring av smärtprognosen. Smärta och stress variablerna visade genomgående bättre värden, dock få statistiskt signifikanta förbättringar.
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